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- Efficacy and safety of erenumab for nonopioid medication overuse headache in chronic migraine a phase 4, randomized, placebo-controlled trialPublication . Tepper, Stewart J.; Dodick, David W.; Lanteri-Minet, Michel; Dolezil, David; Gil-Gouveia, Raquel; Lucas, Christian; Piasecka-Stryczynska, Karolina; Szabo, Gyoengyi; Mikol, Daniel D.; Chehrenama, Mahan; Chou, Denise E.; Yang, Yiping; Lima, Gabriel Paiva da SilvaIMPORTANCE Patients with chronic migraine and medication overuse headaches (CM-MOH) represent a particularly burdened subpopulation. This trial provides first, to our knowledge, American Academy of Neurology class I evidence for a preventive therapy in CM-MOH. OBJECTIVE To assess erenumab efficacy and safety in patients with nonopioid CM-MOH. DESIGN, SETTINGS, AND PARTICIPANTS This randomized, double-blind, parallel-group, placebo-controlled trial took place at 67 centers in North America, Europe, and Australia from October 7, 2019, to November 2, 2022. This report reflects the primary analysis conducted in January 2023, using a database snapshot from December 1, 2022, which contains the complete dataset of the double-blind treatment period (DBTP). Participants included adults with CM-MOH who had 1 or more preventive treatment failure(s). There were 992 participants screened and 620 participants enrolled (584 in nonopioid cohort and 36 in opioid cohort) INTERVENTIONS Erenumab, 70 mg, 140 mg, or placebo, once monthly for 24 weeks. MAIN OUTCOMES AND MEASURES The primary end point was MOH remission at month 6. Secondary end points included change from baseline in mean monthly acute headache medication days (AHMD) at month 6 and sustained MOH remission throughout the DBTP. Safety end points were adverse events and changes in vital signs. RESULTS The primary analysis population included 584 participants in the nonopioid-treated cohort with a mean age of 44 years and 482 participants were female (82.5%). Baseline demographics and disease characteristics were balanced across groups. At month 6, 134 participants in the erenumab, 140 mg group (69.1%) (odds ratio [OR], 2.01; 95% CI, 1.33-3.05; P < .001 vs placebo) and 117 in the erenumab, 70 mg group (60.3%) (OR, 1.37; 95% CI, 0.92-2.05; P = .13 vs placebo) achieved MOH remission vs 102 participants in the placebo group (52.6%). AHMD use was also reduced in the erenumab groups vs placebo. Least squares mean (standard error) change from baseline in average monthly AHMD was –9.4 (0.4) days in the erenumab, 140 mg group (difference from placebo, –2.7; 95% CI, –3.9 to –1.6; P < .001) and –7.8 (0.4) days in the erenumab, 70 mg group (difference from placebo, –1.2; 95% CI, –2.4 to –0.1; P = .03), vs –6.6 (0.4) days in the placebo group. MOH remission throughout the DBTP was sustained in 119 participants (61.3%,) 96 participants (49.5%), and 73 participants (37.6%) in the erenumab, 140 mg, 70 mg, and placebo groups, respectively. Adverse events were consistent with the known safety profile of erenumab. Treatment-emergent adverse events incidence in the combined erenumab group was 66.8% (259 participants; constipation 15.2% (59 participants) and COVID-19 13.9% (54 participants) were most common. CONCLUSIONS AND RELEVANCE In this study, monthly, 140 mg, erenumab injections safely and effectively achieved MOH remission in patients with nonopioid CM-MOH within 6 months.
- Unveiling the burden: a six-year retrospective analysis of pressure ulcer epidemiology in a ICUPublication . Vieira, Sofia; Mostardinha, António; Alves, PauloObjective: This study describes the epidemiological changes in pressure ulcers (PUs) in a Portuguese intensive care unit (ICU) from January 2017 to June 2023, characterizes critically ill patients with PUs, identifies specific risk factors, and assesses the effectiveness of implemented preventive measures. Materials and Methods: A retrospective observational cohort study was conducted, analyzing records of ICU patients with PUs during the specified period. Data were extracted from the institution’s Global Risk Management application and the ICU’s electronic PU registry. The study included patients with ICU stays longer than 24 h and excluded those with ineligible clinical records or incomplete characterization data. Results: Among 3816 evaluated patients, 257 developed a total of 345 PUs, averaging 1.4 PUs per patient. The average PU prevalence rate was 6.81%, with the highest prevalence in 2020 (11.0%) and the lowest in 2022 (3.48%). The average incidence rate was 3.76%, peaking at 5.71% in 2020 and declining to 2.54% in 2023. The sacrum and heels were the most commonly affected areas, with Category 2 PUs being the most frequent. Key intrinsic risk factors included systemic diseases and sensory deficits, with pressure identified as a significant extrinsic factor. Preventive measures focused on risk assessment and pressure control. Conclusions: The study reveals a PU prevalence of 6.81% and an average incidence of 3.76%, underscoring the need for enhanced preventive strategies, especially in anatomical areas like the sacrum and heels. It emphasizes the importance of personalized assessments, continuous education for nursing staff, and a multidisciplinary approach to improve patient outcomes and care quality in the ICU.
- Bank competition and information productionPublication . De Marco, Filippo; Petriconi, SilvioWe show that bank competition diminishes banks' incentives to produce information about prospective borrowers. We exploit the deregulation of US interstate branching as a shock to competition and use borrowers' stock returns after loan announcements to measure bank information production. Positive loan announcement returns are reduced in states that deregulate interstate branching, especially for opaque and bank-dependent firms and smaller banks that rely on soft information. Existing (i.e., inside) banks reduce information production more than new (i.e., outside) banks after deregulation, suggesting that they do so to deter borrower poaching. Furthermore, the probability of a covenant violation increases following deregulation.
- Recommendations for the implementation of a national lung cancer screening program in Portugal - a consensus statementPublication . Fernandes, M. G. O.; Dias, M.; Santos, R.; Ravara, S.; Fernandes, P.; Firmino-Machado, J.; Antunes, J. P.; Fernandes, O.; Madureira, A.; Hespanhol, V.; Rodrigues, C.; Vicente, C. A.; Alves, S.; Mendes, G.; Ilgenfritz, R.; Pinto, B. S.; Alves, J.; Saraiva, I.; Bárbara, C.; Cipriano, M. A.; Figueiredo, A.; Uva, M. S.; Jacinto, N.; Curvo-Semedo, L.; Morais, A.Lung cancer (LC) is a leading cause of cancer-related mortality worldwide. Lung Cancer Screening (LCS) programs that use low-dose computed tomography (LDCT) have been shown to reduce LC mortality by up to 25 % and are considered cost-effective. The European Health Union has encouraged its Member States to explore the feasibility of LCS implementation in their respective countries. The task force conducted a comprehensive literature review and engaged in extensive discussions to provide recommendations. These recommendations encompass the essential components required to initiate pilot LCS programs following the guidelines established by the World Health Organization. They were tailored to align with the specific context of the Portuguese healthcare system. The document addresses critical aspects, including the eligible population, methods for issuing invitations, radiological prerequisites, procedures for reporting results, referral processes, diagnostic strategies, program implementation, and ongoing monitoring. Furthermore, the task force emphasized that pairing LCS with evidence-based smoking cessation should be the standard of care for a high-quality screening program. This document also identifies areas for further research. These recommendations aim to guarantee that the implementation of a Portuguese LCS program ensures high-quality standards, consistency, and uniformity across centres.
- Application of microalgae as natural colorant for pastry and confectionary productsPublication . Pereira, Tatiana; Barroso, Sonia; Pinto, Filipa R.; Silva, Frederica; Teixeira, Paula; Mendes, Susana; Gil, Maria M.Modern consumers demand the replacement of synthetic colorants with natural alternatives. Microalgae can serve as an alternative source for these colorants since they hold significant amounts of pigments. This study aimed to evaluate the potential of using microalgae biomass and extracts as natural colorants for pastry and confectionary products. The application of different biomass and levels of Chlorella vulgaris (White, Honey, and a mixture of both) was evaluated in brioche-type breads as egg substitute to confer the typical yellow coloration to the product. A mixture of 1% Chlorella vulgaris (White: Honey [1:1]) showed potential as egg substitute, having minimal impact on the physical–chemical, microbiological, nutritional, and sensory characteristics of the products. Hydroalcoholic Tetraselmis chuii extracts were applied in fondant at a concentration of 0.05%, providing a green coloration with minimal impact on the quality of the product. This study supported the potential of using microalgae, biomass, and extracts, as alternative natural colorants in pastry and confectionary products.
- Growing out of overconnection: the process of dis/connecting among Norwegian and Portuguese teenagersPublication . Jorge, Ana; Agai, Mehri; Dias, Patrícia; Martinho, Leonor Cunha VazYoung people struggle with permanent online connection that is associated with their generation. This article looks at teenagers’ affective relationship to connectivity and disconnectivity, and how it is socioculturally influenced by the media, family, and peers. It reports on an interview study with 36 teenagers between 15 and 19 years of age from Norway and Portugal. Our findings evidenced how disconnection may arise out of a latent feeling of “disaffect” generated in the experience of the ambience of connected and platform culture as well as the media; or of the unavailability created by how teenagers spend their leisure time, which is influenced by families’ moral economies. Teenagers have to perform affective labor in managing the different, sometimes contradictory, forces that converge in the experience of connectivity. Managing digital disconnection appears as an individual—but socially produced—moral obligation to self-govern, to which teenagers have unequal conditions.
- Chitosan coatings reinforced with cellulose crystals and oregano essential oil as antimicrobial protection against the microbiological contamination of stone sculpturesPublication . Silva, Nádia C.; Madureira, Ana Raquel; Pintado, Manuela; Moreira, Patrícia R.The proliferation of microorganisms in outdoor stone sculptures and cultural objects can damage the structure and aesthetics of the materials through biodeterioration mechanisms. Biocides and synthetic products are often used to prevent this phenomenon, despite their negative impact on the environment and human health. Less toxic alternatives with reduced environmental impact can be an option for the preventive conservation of stone sculptures to reduce the environmental impact. In this work, chitosan formulations reinforced with two types of cellulose crystals (microcrystalline cellulose (MCC) or cellulose nanocrystals (CNCs)) and with or without citric acid and sodium tripolyphosphate were prepared. The films obtained with these formulations showed low solubility, and those only containing MCC or CNCs had the lowest wettability. The formulation containing 2% (w/v) MCC was selected for further analysis and supplemented with oregano essential oil (OEO) at 1% (v/v) and 2% (v/v), exhibiting low solubility, swelling and wettability when polymerised in film form. Inoculation of the films with Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa and Rhodotorula spp. resulted in total or partial inhibition of their growth, as well as a 60–100% reduction in Penicillium chrysogenum growth, depending on the concentration of OEO. The formulation with 2% (v/v) OEO was applied to samples of granite, marble and limestone, forming a protective, yet irregular coating on their surfaces. The wettability of the stones’ surfaces was reduced without becoming completely water-repellent and the coating did not cause visible colour changes.